As I’m writing this, my rear gums are inflamed and aching. I’ve been alternating between sipping a cocktail before bed and downing extra-strength ibuprofen, acutely aware that one should not take the two together due to the potential for internal bleeding. I’m 32 years old, and my wisdom teeth are breaking through. Again. A half dozen years ago the first one emerged, skin ripping apart to make room, and I understood then the pain that a baby feels when their first teeth come in. Every so often another wisdom tooth emerges a little more, and the pain lingers for a few weeks. It’s old hat now. Give me my cocktail, my pills.

I grew up in a small town in West Virginia, and perhaps will soon confirm the stereotype that Appalachians are frequently missing their teeth. My mother cleaned houses for a living and my father worked full-time as a construction worker — jobs that came without health insurance. We were a lower-middle-class and doctor-averse family. You learn to avoid doctors after seeing the unbelievable expense of an uninsured visit to an emergency room, the cost of a child’s earache wiping out a week or more’s worth of pay. I ended up being the one who did well, who got away, a first-generation college student who made it not only to the ivory tower, but the Ivy League. I skipped a few class-climbing steps and seemed to prove to those around me that the American dream was still alive.

During one of my first college breaks, in 2004, I came home with tooth pain. Well, actually, it was teeth pain. Years of neglect, years of avoiding the dentist because I couldn’t afford even a routine cleaning, had finally added up. I came home and made an appointment, desperate to ease the near-constant throbbing in my jaw. And then the shock set in. I was only 19 years old, and the dentist said I had more than $12,000 worth of work waiting for me. I would need several root canals, crowns, and fillings. The dentist also told me I ought to fix my semi-black front tooth, which I had broken as a teenager. It had originally been fixed with a metal screw during a rare visit to the dentist, a visit only undertaken because missing half of a very visible front tooth was too much for even my family. My friends at my Ivy League college, people who had typically grown up with more than enough money to see a dentist every six months, never failed to remark on the oddness of that black tooth, getting darker with every passing season.

I ignored the pain until I learned to live with it, and became that guy who never open-mouth smiles in pictures.

My mother cried back then, when the dentist told her the cost: It was a third of my family’s annual income. It was, in other words, impossible. I cried too. I was already working my way through college; there was simply no time left for me to work off a $12,000 bill and keep up with my classes. So I ignored the pain until I learned to live with it, and became that guy who never open-mouth-smiles in pictures. It was an awful realization. Just when I thought I had escaped the confines of my poor background in West Virginia, as I was building the kind of life that I thought would make me financially secure, there was that ugly pain: a throbbing in my mouth that made me question if I’d ever be part of that other, privileged world.

I’m still not there, 13 years later, and the $12,000 tab has only ballooned over time. All four of my wisdom teeth ought to be removed. I have a broken molar, at least three deep cavities that will require root canals and crowns, and who knows how much minor work. I fear that the broken molar is now too far gone and will need to be removed and replaced with an implant — which alone can cost as much as $10,000. This doesn’t take into account that I live in New York now, where the cost of dental work is just a tad more expensive than it was in West Virginia. And so this is how it spirals, the lingering bacteria from one cavity exacerbating the decay of the other teeth, the loss of confidence, the social shaming. A hopeless cycle.

A few years ago, after getting through graduate school and settling into an office job that had decent insurance, I made myself an appointment. The dental insurance plans I’ve had cap out at $1,500 or $2,000 a year (with only 50% covered for major work), so I braced myself for the long haul. The dentist looked at my mouth and said, “Wow.” The dentist said, “For people like you, we like to work in stages.” I tried to keep up with the dental work and maximize what my insurance provides, while balancing the expensive rent of New York and the cost of living any kind of modern life. But after a half dozen visits, when the first few crowns ate up more than $10,000 of my hard-earned savings — a sum I’d spent a decade amassing — I threw in the towel.

I wasn’t going to go in deep debt over my teeth. I wasn’t going to spend my thirties constantly broke because of dental work. I wasn’t going to rob my spouse of another vacation by spending another year’s worth of savings on partially fixing my mouth. After all the work I’d had done, my husband and I were already living month to month, despite our careful budgeting. I wanted something more — a life in which I could dream of things like putting a down payment on a first home, a life in which having a child, if I ever decided I wanted one, wouldn’t seem like such a selfish decision.

ADVERTISEMENT

It’s an impossible choice to have to make: to have a good life or to have good teeth.

It’s an impossible choice to have to make: to have a good life or to have good teeth. I say this because I know that some people would fault me for my choices, would accuse me of being not quite “by-the-bootstraps” enough for their tastes. They could point to my desire to enjoy a bottle of wine and an occasional cut of fancy cheese, to the fact that I have a laptop and an iPhone, that when I travel to visit one of my out-of-town friends, I like to take the train instead of the bus. And I do sometimes feel guilty for these indulgences. I feel guilty that I ever made my spouse choose between us having an emergency fund and me having a clean bill of health. There are days when I wonder how much better off he’d be without me, both financially and psychologically. And that’s why I’ve chosen to live with the pain, despite my husband’s desire that we focus on getting me better. I’ve become a frequent customer at my local Duane Reade, where I buy that cheap temporary dental filling that comes in a little blue canister. I smudge it in the back of my mouth, in the hole of my broken molar, biding my time until the system changes or the tooth falls out. I can’t bring anyone else down with me.

I have a friend from my old hometown in West Virginia who also lives in New York. She has a master’s degree and a nice, well-paying job now, but also suffers from dental issues. She said to me, “People who are born poor are never able to get ahead.” And that’s the most obvious truth, I think, and one that’s magnified when other factors like race, religious background, and educational attainment come into play. My friend and I are “strivers,” I suppose, but it’s hard to strive when you don’t have the huge deposit to put down on that first city apartment, when you are afraid to smile at an interview because the manager might wonder what the hell is wrong with your mouth.

One night over dinner, my friend told me the story of a woman she had known back in West Virginia. They were in college together, in their early twenties. The woman’s dental problems became so bad that she opted to have all of her teeth removed and replaced with a set of dentures rather than deal with any more pain or the crippling costs of dental care. This woman had been a striver once too. We can never, it seems, escape our childhoods.

In my desperation to have a pain-free, healthy mouth, I’ve researched, contemplated, and tried nearly every option that’s out there. During one of my more painful dental bouts (the big ones come and go), I found out about the low-cost clinic run by NYU’s dental school — low-cost, but not free. I thought I could finally have a little work done. Because the clinic is run by student dentists and each procedure needs to be checked by a master dentist on staff, the process moves slowly and the amount of appointments nearly doubles. On my second visit, the teaching dentist examined my mouth and confirmed the student’s long list of recommended treatments. The teaching dentist said, “What did you do to your mouth? Why have you let it get like this?”

I may not have good teeth, but I still have a modicum of dignity.

I was angry, and shot back that I had grown up poor, that I brushed my damn teeth multiple times a day just like anyone else. “No,” she said. “You should have taken care of your teeth.” I was so upset by the experience, so embarrassed and humiliated, that I decided not to go back. Well, that’s not entirely true; I did go back a couple years later, desperate, in another bout of pain. And I was treated almost exactly the same way. I may not have good teeth, but I still have a modicum of dignity.

Back in 2004, when I received that first impossible bill, my mother said to me, “I have a dead tooth.” She pointed to the back of her mouth. “It’s turning black, and one day it will just fall out.” I think of those words now not as a warning, but as a statement of solidarity. Her words were a reminder of how hard she’d worked scrubbing other people’s floors to get me up and out, even at the expense of her own well-being, her own decaying teeth. She was saying that, for me, there was still hope. I want to believe that she was right, that she’s still right, that I could still yet achieve all the dreams she had for me. But I wonder often, despite my fancy college degree, despite how far I’ve come, if some hurdles are truly insurmountable.

When health care costs spiral out of control (and access to even the most basic medical insurance, let alone dental coverage, is far from certain), when the long-term effects of untreated medical issues catch up with us as adults, there can seem like no way out. At the moment, I don’t see an immediate way out. I’m a published author. I teach college writing. I work hard, but every single day I have to make a choice between paying the rent and student loans, having a vacation, or literally throwing every penny of my savings toward a fraction of the cost of my dental work. And I’m one of the lucky ones, because my dental pain comes and goes. I can afford the luxury of pain-numbing cocktails and extra-strength ibuprofen. Those with more painful or life-threatening conditions don’t have the choice to ignore it.

Before all of the dental pain and the problems began for me, I truly bought into the belief that I could work my way into a better life. I made it out of a small town in Appalachia, I attended a great college, and I have begun to build a meaningful career. I just didn’t realize there would be one big catch: that I’d forever be weighed down, financially and otherwise, by a series of events and circumstances that occurred mostly without my knowledge, and uniformly without my consent.

In a more equitable world, I’d smile toothsome and wide for my husband — who, though he’s from a different background, has never looked at me like an alien or a charity case. I’d go to bed without worrying whether the effects of painkillers and alcohol will be enough to get me through the night. I’d walk into a dentist’s office for a cleaning and nothing else. I’d tell the dentist, “See, it’s possible for a poor boy from West Virginia to make something of himself.” Some days I can almost taste it, that other world. But right now my mouth hurts too much to taste much of anything. ●

Jonathan Corcoranteaches writing at Rutgers University - Newark and the West Virginia Wesleyan College low-residency MFA program. His debut story collection, The Rope Swing, is a 2017 Lambda Literary Awards finalist.